ASIA: EARTHQUAKE & TSUNAMIS FOCUS ON HEALTH

ASIA: EARTHQUAKE & TSUNAMIS FOCUS ON HEALTH 3 February 2005 The Federation s mission is to improve the lives of vulnerable people by mobilising the power of humanity. It is the world s largest humanitarian organization and its millions of volunteers are active in over 181 countries. In Brief Revised Preliminary Appeal No. 28/2004; Operations Update no. 35; Period covered: 26 December - 3 February 2005; Appeal coverage: 103.9% (Click here to view the provisional contributions list attached, also available on the Federation s website). Highlights of the Day: This Operations Update focuses exclusively on health activities of the International Red Cross and Red Crescent Movement to date in tsunami-affected countries. There will be an update of the overall operation tomorrow. An initial rapid assessment in Indonesia, Sri Lanka and the Maldives, carried out by the World Health Organization found that five to 10 per cent of the affected population may develop stress-related disorders as a result of the disaster. This could mean up to 100,000 people are in need of skilled mental health interventions. The Indonesian Ministry of Health reported that 79,842 children in Aceh and North Sumatra had been vaccinated against measles by 30 January in a campaign coordinated with UNICEF and partners, including the Red Cross and Red Crescent. Appeal history: Preliminary appeal launched on 26 December 2004 CHF 7,517,000 (USD 6,658,712 or EUR 4,852,932) for six months to assist 500,000 beneficiaries. Disaster Relief Emergency Funds (DREF) allocated: CHF 1,000,000. Revised Preliminary Appeal issued on 30 December 2004, for CHF 67,005,000 (USD 59,152,246 or EUR 53,439,988) for two million beneficiaries for six to eight months. The Preliminary Appeal was originally launched titled Bay of Bengal: Earthquake and Tsunamis. The title was subsequently changed to Asia: Earthquake and Tsunamis in the Revised Preliminary Appeal launched on 29 December 2004. Operations update No. 16 revised the Revised Preliminary Appeal 28/2004 budget to CHF 183,486,000 (USD 155,286,000 or EUR 118,669,000) with programme extensions for particularly Sri Lanka, Indonesia, the Maldives and East Africa. Click here for contact details related to this operation 0068E/08.03.04

Asia: Earthquake and Tsunami; Appeal no. 28/2004; Operations Update no. 35 2 Background The magnitude 9.0 earthquake that struck the area off the western coast of northern Sumatra on Sunday morning, 26 December 2004, at 7:59 am local time (00:59 GMT) triggered massive tidal waves, or tsunamis, that inundated coastal areas in countries all around the Indian Ocean rim from Indonesia to Somalia. Sri Lanka, the Indonesian province of Aceh, four states of southern India, the Maldives, and coastal areas of Thailand, Malaysia, and Myanmar were the most severely affected. The earthquake epicentre was located at 3.30 N, 95.78E at a depth of 10 kilometres. The area is historically prone to seismic upheaval due to its location on the margins of tectonic plates. However, tidal waves of this magnitude are rare and therefore the level of preparedness was very low. Thousands of staff, relief and medical personnel, and volunteers of the Red Cross and Red Crescent societies of the tsunami-affected countries have provided a vital initial response, in search and rescue, clean-up, providing temporary shelter and immediate relief assistance, emergency medical services, psychological first aid and tracing. It is estimated that over 10,000 Red Cross and Red Crescent volunteers and 76 relief and medical teams have been mobilised in the disaster-affected areas. The Federation immediately launched a Preliminary Emergency Appeal on the day of the disaster with a focus on Sri Lanka, Indonesia and the Maldives. On 3 January 2005, the ICRC launched budget extensions additional to its 2005 Emergency Appeal for Indonesia and Sri Lanka. Along with initial support from the country and regional delegations, the Federation deployed within 24-72 hours three Field Assessment and Coordination Teams (FACT) and 18 Emergency Response Units (ERU) in the sectors of water and sanitation, health care, aid distribution, telecommunications, and logistics/transportation to Sri Lanka, Indonesia and the Maldives. A total of 125 relief flights have now arrived in the various affected countries and a further 21 flights are in the Federation relief pipeline, making a total of 146 relief flights coordinated through the Federation. The Federation and the ICRC in Geneva are currently working on an organizational framework for Movement coordination in the tsunami operations. A note has been sent out to national societies and delegations on this today, for consultation. It is expected that the framework, which will set in place strong platforms for coordination, will be finalised shortly, and a final note will be then sent out by the Federation and the ICRC. Indonesia Summary of the human toll caused by the tsunami as of 3 February Countries Dead Missing Displaced Homeless Sources Indonesia* 237,071 - n/a 617,159 Government Sri Lanka 30,957 5,637 396,295 480,000 Government India* 16,389-647,599 20,000 Government Maldives 82 26 21,663 n/a Government Thailand 5,393 3,071 n/a n/a Government Myanmar 61 10 n/a 3,200 Government Malaysia 68 12 n/a 4,296 Delegation East Africa 313 n/a 50,000 n/a Government Total 290,334 14,396 >1,115,557 >1,124,655 *In Indonesia and India, the number of dead includes persons previously listed as missing. Note: East Africa covers tsunami-affected countries of Kenya, Madagascar, Seychelles, Somalia and Tanzania. Overview The earthquake and resulting tsunami of 26 December 2004 devastated most towns and villages as well as hundreds of kilometres of coastline along the west and north east coasts of Sumatra, in Indonesia. Latest government estimates (from 31 January) put the total number of dead and missing at 237,071 with an additional 617,000 displaced persons. Initial assessments following the disaster made it apparent that the main priorities were to provide immediate assistance to victims of the tsunami, as well as to bolster the badly affected provision of basic health care services. Proper hygiene and nutrition were two other areas of concern identified early on, particularly with regard to conditions within the internally displaced people (IDP) camps and in the more remote and inaccessible areas along the western coast of Aceh. Furthermore, the need for psychological support has been identified as an area requiring organized follow-up as a matter of urgency. A rapid initial assessment by the World Health Organization (WHO) estimates that up to 50 per cent of the affected population may be experiencing significant psychological distress and that five to 10 per cent may develop some stress-related psychiatric disorder as a result of the disaster. This could mean that up to 100,000 people are in need of skilled mental health interventions.

Asia: Earthquake and Tsunami; Appeal no. 28/2004; Operations Update no. 35 3 Much of the infrastructure in the affected area was decimated. Road access to most villages along the west coast was and remains completely disrupted. The Indonesian government has estimated that one million homes were destroyed, along with 450 kilometres of road and scores of bridges. The nature of the disaster and its destructive impact, the potentially volatile conflict on the ground, the constant population movement and psychological impact on the community has made this a challenging operating environment for all components of the Movement to reach and provide essential services to the affected population. However, despite initial fears of outbreaks of communicable diseases, no epidemics have occurred to date in the affected areas. Instances of malaria, measles and watery diarrhoea although present are lower than anticipated and are within acceptable thresholds. The main unexpected health problem encountered was tetanus, due to the types of injuries sustained by tsunami victims. Respiratory problems have also been noted, as a result of the large amounts of sea water and mud ingested by the survivors. In response to the acute nature of the disaster, many nations deployed teams with tertiary health skills to address the severe wounds of the injured. According to an inter-agency analysis carried out under the auspices of the UN s Office for the Coordination of Humanitarian Affairs (OCHA), this resulted in an oversupply of tertiary care facilities and medical staff. Most field hospitals have noted a significant decrease in patient load after the first week post-tsunami, to current more normal daily caseloads. One of the problems noted by the inter-agency assessment has been the absence of a master list detailing the overall medical supplies and drugs being provided to interim health posts. This has resulted in shortages of materials such as wound dressing kits, stethoscopes, delivery kits for safe birth and other common supplies. However, the main problem remains the lack of a coordinated response for health-related assistance due to the large and often unexpected influx of non-governmental organizations (NGOs) into the affected area. On 30 January, the Indonesian Ministry of Health reported that the measles vaccination campaign being coordinated with UNICEF and partners, including RCRC, had covered 79,842 children in Aceh and North Sumatra. A standardized health reporting system for communicable disease outbreaks has been established, but this is not yet being used across all agencies. WHO has expressed concern about resistant strains of tuberculosis (TB) arising, due to the disruption of Aceh s TB treatment programme. The network of community health centres (puskemas) the backbone of the public health system was severely impacted by the tsunami. The government has estimated that six of the area s 26 hospitals as well as 77 of its 234 health centres were partially or completed damaged. Out of the 9,800 Ministry of Health staff in Aceh, 849 have died or are unaccounted for. As a result, most ongoing medical needs of the affected population relate to the restoration of primary health care and preventive services. RCRC Response Over one month after the disaster struck the region, the RCRC Movement continues to be at the forefront in providing health care services to the affected population in Aceh. In particular, Palang Merah Indonesia (PMI)/Indonesian Red Cross has been a key player in providing initial emergency and ongoing basic health care services to the community. Teams of PMI volunteers were involved in body recovery efforts since the beginning, with some 1,423 volunteers deployed by PMI up to the end of January. In addition, PMI rapidly established 15 health posts and 11 mobile clinics, providing health care to an estimated 70,000 people since the disaster. The organization is also actively participating in the Ministry of Health/UNICEF measles vaccination campaign, with support by the British Red Cross health delegate and a member of the Federation s office team in Meulaboh. The Banda Aceh branch has been active in disinfection and vector control programmes. Furthermore, additional volunteer medical teams were dispatched spontaneously by PMI branches to the affected area. Exact numbers of patients treated are currently being compiled by the various chapters, as PMI focuses on achieving a complete and accurate picture of assistance provided as part of the overall tsunami response and begins detailed planning for the recovery and rehabilitation phase. An expanded organizational structure is currently being put into place and data is being systematically recorded by chapters (including number/type of patients, as well as medicines and medical supplies).

Asia: Earthquake and Tsunami; Appeal no. 28/2004; Operations Update no. 35 4 PMI action was complemented with support from the Federation and ICRC, along with Movement partners from Japan, Germany, Turkey, Malaysia, Denmark, France, Taiwan, Norway, Switzerland, Korea, Singapore and Slovakia (according to information received to date) who together have or are still providing vital services to affected communities along the west coast (Meulaboh, Teunom, Calang, Lamno, Patek), Simeulue Island and on the north-east coast (Sigli through to Samalanga). A Federation field assessment and coordination team (FACT) was deployed within 72 hours of the disaster, basing itself out of Banda Aceh as soon as logistically feasible. By 3 January, FACT members were conducting aerial and rapid touchdown assessments by helicopter of the districts of Aceh Jaya, Aceh Barat and Simeulue Island. Two RC basic health care emergency response units (ERUs) of the Japanese and German Red Cross Societies were set up in two of the most affected population centres along the west coast Meulaboh and Teunom, respectively. These also acted as operational bases and enabled the teams to pursue ongoing assessments in the surrounding communities, in order to identify pockets of IDPs requiring medical assistance. In mid-january, with support from the Norwegian Red Cross, ICRC set up a referral hospital in Banda Aceh with an inpatient capacity of 100, to ease the burden on overwhelmed Banda Aceh hospitals, and to act as a referral hospital for patients in outlying areas of the west coast. In addition, ICRC has set up camp for up to 400 discharged IDP patients and their relatives, to provide shelter and follow-up medical services. The table below provides an up-to-date overview of RCRC health activities at the end of January: RCRC German RC ERU BCHU (as from 10 January 2005) Japanese RC ERU BCHU (as from 4 January 2005) ICRC Hospital (as from 16 January) Communities served Teunom Meulaboh + outlying communities (Ache Barat, Nagan Raya) Activities Beneficiaries Constraints / Comments Basic health care services Medical support to Cut Nyak Dhein hospital (ICU, ER, OT) BHCU in IDP camp Needs mapping in outlying villages Mobile health clinic to IDP camps Measles + tetanus vaccination Serving a population of up to 20,000 75 patients/day (OPD) cumulative (30 Jan): 2,519 Up to 300 patients / day overall at the hospital. BHCU in IDP Total patients (25 to 30 January): 324 Vaccinations (to 27 Jan): tetanus: 1,602 measles: 214 Banda Aceh Referral Hospital 2,500 OPD (16 to 30 January) + average of 44 inpatients/day Team rotation now complete. Health assessment being carried out on Simeulue Island Also setting up a camp for discharged patients (up to 400) PMI Banda Aceh, Lam No, Calang, Simeulue Meulaboh Mobile health teams 34 doctors and 28 paramedics / nurses Doctor working with BCHU + 30 PMI volunteers Estimated cumulative total of 70,000 patients (at 27 January) 8 to 12 teams operational at any one time. Other teams deployed directly by PMI chapters to affected area.

Asia: Earthquake and Tsunami; Appeal no. 28/2004; Operations Update no. 35 5 Red Cross and Red Crescent action - objectives, progress/achievements, impact, constraints Overall Goal: Up to 100,000 internally displaced and otherwise affected families (approximately 500,000 people) in western Aceh receive adequate and timely emergency humanitarian assistance over the next six months. Objective 3 (health): primary health care service provided to the tsunami-affected communities and potential epidemics are prevented or adequately addressed. Progress/Achievements The Federation s ERUs, working in close collaboration with PMI, have provided health care in the following areas: Meulaboh - Japanese Red Cross Society s basic health care unit (BHCU) ERU The Japanese Red Cross Society has continued to play a significant role in the general coordination of hospital activities, in close collaboration with the authorities and in ensuring critical health care support during the first weeks following the disaster. With many other organizations subsequently arriving on the scene, the Japanese RC is now focusing its activities in four areas: 1. hospital support activities mainly surgical (from 4 January); 2. mapping of surrounding villages in coordination with local authorities, identifying IDPs and providing basic health care if needed; 3. mobile health clinics to IDP camps (from 8 January), as well as the newly established basic health care unit (BHCU) in the recently set up and rapidly expanding Meulaboh IDP camp (from 25 January); and, 4. tetanus and measles vaccination campaigns (from 18 January). On 2 January, the Japanese health care ERU advance team travelled to Meulaboh to establish its forward base camp. Early assessments showed that the Meulaboh hospital had been seriously affected by the disaster with only 20 of the original 70 beds available and medical staff severely depleted (only five of nine doctors and 10 of 154 nurses are thought to have survived the disaster). During the first weeks, unsurprisingly, patient numbers were higher than normal. The hospital s out-patient department (OPD) was seeing 300 to 500 patients per day, before stabilizing at pre-tsunami levels of 50 to100 patients per day. The number of operations immediately after the disaster was 10 to 15 per day, compared to two to five per day normally. The Japanese BHCU ERU aimed to fill the gap in medical care in Meulaboh by working together with the hospital s medical team in particular, supporting the intensive care unit, emergency room and operation theatre in close coordination with the hospital s director and PMI, along with staff from the Korean Red Cross, Medecins Sans Frontieres (and the Singapore Army during the first weeks, as well as other NGOs), ensuring that the hospital remained operational 24 hours per day. On 8 January, the Japanese ERU team also began running a mobile health clinic for IDP camps, providing medicines and medical supplies, public health surveillance, and triage in IDP camps (focusing on vaccinations and the most vulnerable). Programmes for tetanus vaccination (as a local initiative in coordination with local authorities in Meulaboh) and measles vaccination (in cooperation with UNICEF) were undertaken, with a total of 1,602 people vaccinated for tetanus and 124 for measles by the Japanese team to the end of January. A Japanese RC BHCU was set up in the main IDP camp in Meulaboh and began operating on 25 January. Patient numbers are increasing steadily day by day, averaging approximately 100 patients per day, for a total of 324 to 30 January. Ongoing assessments are being pursued in remote areas to identify IDPs yet to receive medical services, water and sanitation assistance and relief supplies. Most recently, the Japanese Red Cross ERU team participated in an assessment of health needs for Simeulue Island, in conjunction with PMI and local authorities.

Asia: Earthquake and Tsunami; Appeal no. 28/2004; Operations Update no. 35 6 Teunom - German Red Cross BHCU ERU The German Red Cross ERU team (combined water and sanitation and BHCU ERU) arrived in Banda Aceh on 6 January, and set up its equipment and facilities in Teunom on 10 January, based on results and recommendations of the field assessments. This required extensive logistical support, in order to shuttle the 30 tonnes of equipment by helicopter (eight flights) from Banda Aceh to Teunom. The ERU was operational and fully deployed by 12 January, supported by two local doctors and a team of 30 PMI volunteers who provided food to patients and assisted with outreach activities. The Teunom health clinic, which was totally destroyed, had been a focal point for health care to the surrounding area, serving a population of approximately 20,000 people. Main ailments diagnosed during the first weeks included wounds sustained as a result of the tsunami and respiratory track infections due to ingestion of sea water as well as the difficult living conditions, exacerbated by heavy rains. A total of 2,519 patients have been treated by the BHCU in the OPD up to 30 January. Currently, patient numbers are back to pre-tsunami levels (100 to 150 OPD patients per day). The BHCU is working in close collaboration with existing health centre staff, local authorities, military and other NGOs. Some 30 PMI volunteers remain present, including medical personnel, and are fully integrated into the activities of the BHCU. Both ERUs have begun their exit strategy planning, with details to follow. ICRC Referral Hospital The ICRC general referral field hospital in the Lhong Raya stadium of Banda Aceh, which was set up with support from the Norwegian Red Cross, has been in operation since 16 January. It has a 100-bed capacity, supports surgery and maternity delivery, and is complete with medical and surgery wards, a children's ward and an intensive care unit (ICU). The facility is also equipped with a helicopter landing space, which is used by various NGOs to fly in patients from the remote parts of Aceh. At the onset of the operations, the ICRC signed a Memorandum of Understanding (MoU) with the authorities allowing them to operate their hospital for three months, with a possibility for an extension depending on the needs of the community. There were some logistical constraints in setting up the hospital, whereby planes carrying equipment and staff from their hub in Singapore had difficulty finding available landing slots at Banda Aceh; nevertheless, the hospital is now running well and self-sufficiently. To date, the ICRC hospital has provided outpatient treatment to 2,500 patients with an average of 120 to 200 cases a day, and treats an average of 44 admitted patients a day. Currently, most of the treatment sought in the hospital is not directly related to the tsunami, though some long-term treatment is still needed for fractures and wounds incurred in the disaster. Most treatment is sought because the community in the area lacks proper medical and health infrastructure. The ICU unit, however, is the most resource consuming activity of the hospital, where 11 cases of tetanus have been reported. Employees in the hospital are made up of 35 expatriate and 100 local staff, the latter consisting of an even mix of PMI volunteers and locally employed doctors and nurses. Initially, the number of PMI volunteers was high, and the ICRC found PMI nurse trainees to be especially helpful. With the load of critical patients, the hospital is increasingly using the services of professionally trained staff. Although health problems in the community have stabilized, the hospital is still retaining its local staff to free up PMI volunteers to conduct the critical work of relief distribution and body retrieval. Psychosocial support On 2 January, a psychosocial support delegate attached to the FACT arrived in Medan to work with a PMI counterpart in planning and undertaking field assessments, which began on 11 January. The aim was to: support PMI volunteers doing recovery and burial; assess the well-being of the survivor population; and, determine further PSP training requirements. The assessment noted typical post-disaster signs of apathy, withdrawal and a sense of hopelessness. A common preoccupation concerned the future, linked to the extensive loss of livelihoods. The situation of survivors is

Asia: Earthquake and Tsunami; Appeal no. 28/2004; Operations Update no. 35 7 exacerbated by the lack of privacy and difficult living conditions. Groups of survivors were however seen to be actively talking among themselves, in an intuitive effort to deal with their grief. PMI has an ongoing programme for debriefing volunteers as most of them have been involved in the difficult task of body recovery. A stress management fact sheet has now been translated into Bahasa and is being distributed. A programme of psychosocial support has been developed by Danish Red Cross and PMI and is currently being implemented in Meulaboh. Two psychologists are on their way to Banda Aceh, to work with PMI on de-briefing of Satagana teams involved in body recovery. Two additional psychologists will be based in Meulaboh, where they will assist PMI in setting up a programme of psycho-social programme (PSP) activities. The team of psychologists from Danish Red Cross will be working on a four-week rotation schedule. Turkish Red Crescent is also said to be involved in PSP with PMI s Banda Aceh Branch on a bilateral basis. PNS activity The Red Cross and Red Crescent Societies of France (Medan and Meulaboh), Korea (Banda Aceh and Calang), Malaysia (Banda Aceh), Singapore (Meulaboh), Switzerland (Teunom), Norway (ICRC referral hospital), Slovakia (assisting at ICRC hospital), Afghanistan (assessment) and Turkey (Banda Aceh) have all set up or are assisting with health facilities and are attending to the needs of the affected population. The Danish Red Cross is also involved with PMI on an ECHO-funded psycho-social programme for the affected communities, focusing initially on Meulaboh, as described above. Impact The ERU BHCUs and PMI continue to offer basic and specialized health care to an estimated 74,000 beneficiaries. There have been no major disease outbreaks. The most immediate needs have been the treatment of wounds, often severely infected. Other most common complaints have included: respiratory tract infections, with a significant number progressing to pneumonia, diarrhoeal disease, malaria, as well as an unexpected number of tetanus cases. Constraints Extreme congestion and bottlenecks of incoming cargo flights, compounded by overall transportation challenges, leading to delays in delivery of ERU equipment (in particular Japanese Red Cross ERU, which arrived in a piecemeal fashion, in pieces and at the end of the first rotation). This has been an ongoing constraint, only beginning to ease by mid-january. Bulk and weight of ERU equipment made rapid delivery of all equipment difficult. Information on needs and priorities during first weeks was difficult to come by and consolidate, due to the scope (human and geographic) of the disaster. Conflicting information on numbers and location of IDPs (first official IDP map available only on 11 January). Poor weather conditions hampered assessment operations and equipment delivery. Difficult access to affected communities along west coast of Aceh, particularly Calang. Limited offloading capacity. No road access. Constantly shifting IDP population. As a result, the planning for stable provision of health care services to the community is difficult. Concern for patients with nowhere to go once discharged. Influx of humanitarian agencies leading to confusion and difficulties in overall coordination by Ministry of Health and WHO. Difficulty in effectively coordinating RCRC activities, due to unannounced assistance of a number of PNS, as well as widespread nature of operations in scattered and difficult to access locations. Future Plans According to the inter-agency rapid health assessment carried out under the auspices of OCHA on 13 to 19 January in west Aceh, the timely rehabilitation of community health centres is crucial, as is a demand-based logistics system to place drugs and medical equipment within those centres.

Asia: Earthquake and Tsunami; Appeal no. 28/2004; Operations Update no. 35 8 Equally important is the mobilization and/or training of new staff to replace the many health workers who died. Temporary health clinics, which are being staffed by international and local volunteers at intermittent hours, need to cede this role to others: either large NGOs that can provide services on a longer-term basis; or gradual transfer of those responsibilities back to local health authorities. In particular, there seems to be a particular lack of providers who can provide maternal and child health care. The Federation and PMI are working in close cooperation to determine medium and long term plans for health recovery and rehabilitation. PMI has requested assistance from the Federation in the form of a medical logistics delegate to assist the national society in putting the correct structure in place, as well as to build their capacity in this field. In terms of PMI s overall emergency health programme, a draft health organizational structure, from the national board down to field staff level (i.e. Khusus and Satgana teams), covering the whole of the affected area is being developed and has now been put into place in Banda Aceh. The Federation is aiming to provide support to PMI in terms of re-stocking of medical supplies, as well as human resources and capacity-building activities while maintaining BHCU ERUs until an appropriate exit strategy is put into place to ensure ongoing and smooth transition of basic health care in the communities being served. Sri Lanka Overview The health sector in Sri Lanka was severely affected by the tsunami. More than 30 hospitals were partly or completely destroyed and 68 community health posts (CHPs) were affected, some completely destroyed. The response by the Ministry of Health has been outstanding. A number of CHPs have been moved to alternative public buildings and are now operational. Undamaged hospitals are serving extra patients. The support in all medical aspects by local as well as international groups is unprecedented. Most of the 168 NGOs registered in the country were and continue to be involved in some kind of medical relief or rehabilitation, at all levels. Rescue workers and volunteers, as well as victims of the disaster were traumatized and psycho-social support may be required for quite some time, especially for children. In the mid- and longer-term, rehabilitation and reconstruction of hospitals and health posts will be necessary. Despite the disaster, the health situation in the country remains stable. Safe drinking water has been made available to all affected areas, and there have been no reported disease outbreaks. The MoH and WHO maintain surveillance for communicable diseases. Coordination The MoH has prepared a list of all health facilities which need reconstruction, rehabilitation or improvement. The list includes hospitals which may not have been directly damaged by the tsunami, but are stretched to provide services for patients referred from affected areas. At a meeting this week between the MoH, ICRC, the Federation and the Sri Lanka Red Cross Society (SLRCS), the Movement made a commitment to repair 32 structures. This includes at least one district hospital in each affected district, with a good spread between north and south, and between size and type of health facility district hospitals, smaller hospitals and peripheral units, a regional training centre and a dental clinic. A formal agreement is expected within days. One ERU referral hospital (provided by the German Red Cross) with 200 beds has been deployed to the northern district of Mullaitivu under the ICRC integrated project scheme. A further six basic health care units from the Italian Red Cross have been deployed to Batticaloa and Jaffna districts, a direct request from the Sri Lankan MoH to the Italian government. They are operating in cooperation with the ICRC and the Federation. A number of partner national societies (PNS) are in the country making their own assessments of possible longterm health projects. The Turkish Red Crescent Society has a large medical team in place here. Red Cross and Red Crescent action - objectives, progress/achievements, impact, constraints Overall Goal: Up to 40,000 families (about 200,000 people) in the south of the country receive immediate relief, shelter, health and care, and community support over the next six months.

Asia: Earthquake and Tsunami; Appeal no. 28/2004; Operations Update no. 35 9 Objective 4 (health): A constant, good level of health is ensured for up to 20,000 families (about 100,000 people) through prevention and basic health care, as well as health and hygiene promotion. Progress/Achievements Three Federation-coordinated ERUs continue to provide basic health care services on the eastern coast of Sri Lanka. The Finnish Red Cross ERU covers the basic health needs of 12 centres for IDPs between Pottuvil and Komari while the French Red Cross ERU runs mobile health units south of Pottuvil. The Norwegian Red Cross ERU based in Ichichilamapatttai (Trincomalee district) has, to date, attended to over 4,000 patients. The BHCUs report a need for basic health care training/education and also for psycho-social support in their areas of operation. No outbreaks of serious diseases have been observed. Summary of health assistance provided by ERUs District Lead agency Type of ERU Red Cross No. of delegates Location Beneficiaries Ampara ICRC BHCU French 7 Pottuvil 1,200 (approx) mobile health BHCU Finnish 13 (plus 11 local Komari 1,326 mobile health staff) Trincomalee ICRC BHCU Norwegian 7 Ichtilampattai 4,002 Total 3 27 6,528 (approx) Since the start of the operation, the Finnish Red Cross ERU and its satellite clinic has served over 1,300 patients but, in the past week, the number of patients in both clinics is slowly decreasing. The cases include mostly respiratory infections, skin diseases and injuries. The satellite clinic was integrated with the local (temporary) dispensary in Komari village at the end of January. Some supplies from the ERU have been donated to the dispensary and a local doctor is now responsible for managing the dispensary. Longer term health plans of the ERU will be to improve primary health care services in the Ampara district. Emphasis will be on prevention, especially reproductive health (maternal child health and family planning) and improving the quality of care. The Norwegian Red Cross ERU clinic in Ichichilamapatttai is running well, with patients coming in from camps, villages and the countryside for medical treatment. The number of patients in this district also appears to be decreasing with only 780 patients seen in the past week. The out-patient department (OPD) is operated by two Norwegian doctors, two local doctors and two Tamil medical students. The main conditions being treated are respiratory infections, musculoskeletal problems and skin diseases. There is very little diarrhoea, though six cases of dysentery were reported in Sooranagar camp last week and notified to the local health authorities. Three local midwives are working together with the Norwegian Red Cross midwife. The number of pregnant women coming to the clinic has decreased to around 10 cases per week. One reason for this may be the lack of transportation and the family situation in camps. The clinic meets Sri Lankan OPD standards, but includes maternity and 20 beds for overnight patients, who are then transferred to other hospitals or sent home. Impact After one month in the field the ERUs of the Finnish, Norwegian and French Red Cross Societies have provided basic health services to nearly 6,000 patients in areas affected by the disaster. The number of patients seen by the ERUs has started to decline in recent days. It is clear that at this point little need exists for emergency health care services, which are adequately covered by the local health infrastructures. However, as stated in previous updates, the findings from the recovery assessment team expected soon will identify existing gaps that need to be filled. Constraints Many patients have difficulties reaching clinics due to illness or the distance from the basic health care units. This problem is being addressed by the operation of mobile health units. People, in particular children, living in the temporary shelters in camps could face a worsening health situation. Risks will also increase if sanitation problems in the camps are not addressed. Although UNICEF has promised to provide permanent pit latrines in each camp, the process appears to be quite slow. To maintain adequate hygiene

Asia: Earthquake and Tsunami; Appeal no. 28/2004; Operations Update no. 35 10 levels, a latrine also needs to be built for each household; local people are prepared to build the latrines themselves, if materials are provided. Capacity of the National Society The SLRCS volunteers and staff have been engaged in rescue and first-aid activities from the start of relief operations. The national society continues to maintain 10 mobile first aid teams along the southern and western coastline supported by Federation emergency funds. The SLRCS still operates 59 mobile medical units, partly funded by the Federation and deployed in seven coastal districts. A total of 1,850 volunteers trained in first aid work in 13 districts along the coast. India Overview The Indian Red Cross Society (IRCS) responded to urgent health needs at the state branch level in the immediate emergency relief phase. There was close coordination with the significant state government response in the affected states/territories. Five weeks after the disaster, there have been no increases in the incidence of communicable diseases reported in the affected areas (the states of Tamil Nadu, Andhra Pradesh, Kerala, Pondicherry and the union territory of the Andaman and Nicobar Islands). In Tamil Nadu the state branch mobilized 25 doctors and 15 ambulances to provide health care in the worstaffected district of Nagapattinam. Trained Red Cross volunteers joined relief teams and provided psychological support to survivors in three districts. IRCS national headquarters mobilized medicines while the private sector donated medicines and hygiene kits. The neighbouring Karnataka state branch organized clinical services in Cuddalore in Tamil Nadu providing 15 doctors, nurses and a technician. They were involved in dispensing of drugs, dressing of wounds and providing tetanus injections. The Andhra Pradesh state branch mobilized medicines and provided basic health care for affected people in the district of Krishna for 10 days. Maldives Overall Goal: Tsunami affected families in Maldives receive immediate non-food relief, shelter, electricity, health, water and sanitation services; and a national society established. Objective 3 (health): the physical and mental health of the affected population is ensured through the provision of needed basic medical supplies and psychosocial support. Progress/Achievements The American Red Cross psycho-social team concluded its immediate post-disaster phase of the programme. Consultations were held and agreement was reached with the authorities concerned for ongoing support in this area. Under the psychological first aid (PFA) programme, 59 counsellors were trained. A total of 45 people were deployed over 33 days to the 23 worst-affected islands where 18,145 people live. It is estimated that 12,620 people were directly impacted by the programme. A total of 216 teachers from 143 schools were trained under the teachers training programme. The number of children who will be reached through this programme is 64,549. A total of 16 school kits have been distributed to date. More are arriving for distribution through Ministry of Education channels.

Asia: Earthquake and Tsunami; Appeal no. 28/2004; Operations Update no. 35 11 The German Red Cross is in negotiations with the Ministry of Health. It is expected a memorandum of understanding will be signed soon to cover the project to repair damaged hospitals and health clinics and to initiate a first aid and water safety programme through schools. No further medical/health materials are presently required. A total of 400 dressing kits, one set of medical items and 2,000 hygiene kits have been distributed and handed over to the authorities. For further information specifically related to this operation please contact: In Asia: India, New Delhi: Bob McKerrow, Head of Regional Delegation; phone: +91.11.2685.8671, mobile: +91.98.1000.1534; email: ifrcin02@ifrc.org. Sri Lanka: Alisdair Gordon-Gibson; Head of Delegation; phone: +94.77.755.7001 Indonesia: Ole J Hauge, Head of Delegation; phone: +622 1791 91 841; mobile: +628 11 824 859; fax: +622 1 79180 905; email: ifrcid01@ifrc.org and Latifur Rahman, Disaster Management Delegate; phone: +62.811.82.6624; fax: +62.217.18.0905 email: ifrcid05@ifrc.org Myanmar: Joanna Maclean, Head of Delegation, phone: +95.1.383686 email: ifrcmm01@redcross.org.mm Malaysia: Dr Selva Johti, National Disaster Management Chairman, Malaysian Red Crescent Society; phone: +60.2.6138.2325, mobile: +60.1.2234.0310: fax: +60.3.6138.2325 Thailand: Lt. Gen. Amnat Barlee, Director of Relief and Community Health Bureau, Thai Red Cross; phone: +66.2.251.7853 ext. 2202/251.7442, fax: +66.2.252.7976; email: abarlee@webmail.redcross.or.th Thailand, Bangkok: Dr. Ian Wilderspin, Head of Disaster Risk Management Unit, phone: +662.640.8211; fax: +662.661.8220; email: ifrcth22@ifrc.org and Bekele Geleta, Head of Regional Delegation; mobile: +66 18215495; email: ifrcth23@ifrc.org In Geneva: Iain Logan, Head of Tsunami Operations Coordination, Geneva; +41.22.730.4258, email: iain.logan@ifrc.org Indonesia: Charles Evans, Southeast Asia Desk, Geneva; phone: +41.22.730.4320; fax:+41.22.733.0395; email: charles.evans@ifrc.org Sri Lanka: Suzana Harfield, Desk Officer, Geneva; phone: +41.22.730.4353 ; email: suzana.harfield@ifrc.org Myanmar, Malaysia, Thailand, Maldives and Somalia: Wilson Wong, Desk Officer, Geneva; phone: +41.22.730.4302; email: wilson.wong@ifrc.org India: Jagan Chapagain, Desk Officer, Geneva; phone: +41.22.730.4316; email: jagan.chapagain@ifrc.org Media Department, Sian Bowen, phone: + 41.22.730.4428; email: sian.bowen@ifrc.org Logistics Department for mobilization of relief items, Erling Brandtzaeg, logistics officer for Indonesia and Myanmar, Geneva; phone: +41.22.730.4269; email: erling.brandtzaeg@ifrc.org, Mauricio Bustamante, logistics officer for Sri Lanka and Maldives, Geneva; phone: +41.22.730.4267; email: mauricio.bustamante@ifrc.org and Isabelle Sechaud, general coordination of tsunami operations logistics cell, Geneva; phone: +41.22.730.4367; email: isabelle.sechaud@ifrc.org In Africa: Nairobi Regional Delegation; Anitta Underlin, Federation Head of Eastern Africa Regional Delegation, Nairobi; email: ifrcke03@ifrc.org; Phone: +254.20.283.51.24; Fax +254.20.271.84.15; Steve Penny, Regional Disaster Management Coordinator; Phone: +254.20.283.5117; Fax: +254.20.271.8415; email: ifrcke78@ifrc.org In Geneva: Josse Gillijns, Regional Officer for Eastern Africa, Africa Dept.; email: josse.gillijns@ifrc.org; Phone: +41.22.730.42.24; Fax: +41.22.733.03.95 All International Federation assistance seeks to adhere to the Code of Conduct and is committed to the Humanitarian Charter and Minimum Standards in Disaster Response in delivering assistance to the most vulnerable. For support to or for further information concerning Federation programmes or operations in these or other countries, or for a full description of the national society profiles, please access the Federation s website at http://www.ifrc.org Contributions list below; click here to return to the title page.

Asia - Earthquake and Tsunamis ANNEX 1 APPEAL No. 28/2004 PLEDGES RECEIVED 03/02/2005 CASH TOTAL COVERAGE REQUESTED IN APPEAL CHF ----------------------------------------> 183,486,000 103.9% AFRICAN UNION 100,000 USD 113,200 06.01.05 EAST AFRICA ANDORRA, PRINCIP. - GOVT 60,000 EUR 92,580 21.01.05 ANDORRA, PRINCIP. - PRIVATE DONOR 3,086 12.01.05 AUSTRIA - GOVT/RC 450,000 EUR 694,350 10.01.05 MEDICAMENTS, HYGIENE GOODS, PARCELS AUSTRIA - RC 1,500,000 EUR 2,314,500 27.01.05 AUSTRALIAN - RC 2,400,000 AUD 2,119,200 30.12.04 AUSTRALIAN - RC 7,300,000 AUD 6,445,900 31.12.04 AUSTRALIAN - GOVT 4,800,000 AUD 4,238,400 02.01.05 AUSTRALIAN - RC 3,000,000 AUD 2,647,500 24.01.05 AUSTRALIAN - RC 3,000,000 AUD 2,647,500 25.01.05 AZERBAIJAN - PRIVATE DONOR 102 18.01.05 BAHRAIN - PRIVATE DONOR 50,000 USD 56,600 06.01.05 BELGIUM - RC/GOVT 7,186 EUR 11,088 31.12.04 PROGRAMME SUPPORT/KIND BELGIUM - RC 500,000 EUR 771,500 01.01.05 BELGIUM - RC 600,000 EUR 925,800 20.01.05 BOLIVIA - RC 5,356 USD 6,063 24.01.05 BOSNIA & HERZEGOVINA - RC 42,948 EUR 66,269 21.01.05 BRAZIL - PRIVATE DONORS 2,997 18.01.05 BRITISH PETROLEUM FOUNDATION 1,000,000 USD 1,145,000 29.12.04 BRUNEI - PRIVATE DONORS 30,285 USD 34,282 05.01.05 INDONESIA BRUNEI - PRIVATE DONOR 3,600 USD 4,075 04.01.05 BULGARIA - PRIVATE DONOR 10,000 EUR 15,430 14.01.05 CAMBODIA - GOVT/RC 10,000 USD 11,320 05.01.05 CANADIAN - GOVT 3,465,000 CAD 3,336,795 31.12.04 CANADIAN - GOVT/RC 990,000 CAD 953,370 26.12.04 CANADIAN - RC 200,000 CAD 192,600 27.12.04 CANADIAN - RC 5,000,000 CAD 4,815,000 29.12.04 CANADIAN - RC 8,000,000 CAD 7,520,000 20.01.05 EVALUATION OF ACTIVITIES CANADIAN - PRIVATE DONOR 100,000 USD 113,200 06.01.05 CANADIAN - PRIVATE DONORS 570 17.01.05 CHINA - HONG KONG - RC BRANCH 3,713,771 04.01.05 FAMILIY KITS INDONESIA CHINA - HONG KONG - RC BRANCH 3,238,470 29.12.04 TO PURCHASE RELIEF ITEMS CHINA - HONG KONG - RC BRANCH 1,560,515 01.01.05 CHINA - HONG KONG - RC BRANCH 2,971,017 03.01.05 FAMILY KITS INDONESIA CHINA - HONG KONG - RC BRANCH 441,177 07.01.05 PROCUREMENT OF IRON SHEETS MALDIVES CHINA - HONG KONG - RC BRANCH 593,246 13.01.05 PROCUREMENT FOR MYANMAR, OF RELIEF ITEMS CHINA - HONG KONG - PRIVATE DONORS 3,373 04.01.05 CHINA - MACAU - RC BRANCH 500,000 26.12.04 WATER & SHELTER; MEDICAL & RELIEF SUPPLIES IN INDONESIA CHINA - MACAU - RC BRANCH 280,000 30.12.04 SRI LANKA CHINA - MACAU - RC BRANCH 780,000 14.01.05 INDONESIA, MALDIVES, SRI LANKA, EAST AFRICA CHINA - RC 50,000 USD 56,500 31.12.04 THAILAND RC DIRECT CHINA - RC 100,000 USD 113,000 31.12.04 SRI LANKA RC DIRECT CHINA - RC 100,000 USD 113,000 31.12.04 INDONESIA RC DIRECT CHINA - RC 20,000 USD 22,600 31.12.04 MYANMAR RC DIRECT

Asia - Earthquake and Tsunamis ANNEX 1 APPEAL No. 28/2004 PLEDGES RECEIVED 03/02/2005 CHINA - RC 50,000 USD 56,500 31.12.04 INDIA RC DIRECT CHINA - RC 20,000 USD 22,600 31.12.04 MALDIVES DIRECT CHINA - RC 20,000 USD 22,600 31.12.04 MALAYSIA RC DIRECT CHINA - RC 300,000 USD 343,500 28.12.04 CHINA - PRIVATE DONOR 243 25.01.05 COOK ISLANDS - RC 39,380 EUR 60,764 13.01.05 COOK ISLANDS - PRIVATE DONORS 659 EUR 1,016 12.01.05 CROATIA - RC 1,500,000 30.12.04 INDIA, SRI LANKA, INDONESIA, THAILAND CYPRUS - RC 26,540 11.01.05 CZECH REP. - PRIVATE DONORS 3,491 20.01.05 DENMARK - PRIVATE DONORS 340 20.01.05 DENMARK - PRIVATE DONOR 10,000 USD 11,320 18.01.05 DJIBOUTI - PRIVATE DONOR 5,000 USD 5,660 14.01.05 ECHO 3,000,000 EUR 4,549,500 26.12.04 EGYPT - PRIVATE DONORS 141 14.01.05 ESTONIA - GOVT 500,000 EEK 48,100 28.12.04 ETHIOPIA - RC 25,000 USD 28,300 04.01.05 SOMALIA, SEYCHELLES FIDJI - RC 400,000 FJD 276,000 21.01.05 DIRECT CONTRIBUTION TO INDONESIA RC, SRI LANKA RC, INDIA RC, THAILAND RC FINLAND - RC 1,575,000 EUR 2,430,225 05.01.05 FIRST DATA WESTERN UNION FOUND. 1,000,000 USD 1,130,000 31.12.04 PMN to be finalised FRANCE - PRIVATE DONORS 2,710 EUR 4,182 04.01.05 FRANCE - PRIVATE DONOR 10,000 USD 11,320 11.01.05 FRANCE - PRIVATE DONORS 11,260 19.01.05 FRANCE - RC 1,000,000 EUR 1,543,000 26.01.05 OECD STAFF MEMBERS 10,000 EUR 15,430 05.01.05 GERMAN - RC 1,000,000 EUR 1,543,000 18.01.05 GERMANY - PRIVATE DONORS 17,800 30.12.04 GERMANY - PRIVATE DONOR 7,750 EUR 11,958 19.01.05 GREAT BRITAIN - GOVT/RC 400,000 GBP 865,600 30.12.04 INDONESIA GREAT BRITAIN - DFID 1,177,150 GBP 2,567,364 05.01.05 GREAT BRITAIN - RC 100,000 GBP 216,400 28.12.04 GREAT BRITAIN RC 840,642 30.12.04 SRI LANKA TO PURCHASE CLOTHES, MATS, SOAPS GREAT BRITAIN RC 1,000,000 GBP 2,181,000 25.01.05 GREAT BRITAIN - PRIVATE DONOR 20,000 EUR 30,860 30.12.04 GREAT BRITAIN - PRIVATE DONOR 75,000 USD 84,900 07.01.05 GREAT BRITAIN - PRIVATE DONOR 20,000 USD 22,640 04.01.05 GREAT BRITAIN - PRIVATE DONOR 2,181 20.01.05 INDONESIA GREAT BRITAIN - PRIVATE DONORS 19,477 25.01.05 GREAT BRITAIN - PRIVATE DONOR 10,000 GBP 21,810 24.01.05 GREAT BRITAIN - CHARITIES AID FOUND. 61,559 GBP 134,261 19.01.05 HELLENIC - RC 50,000 EUR 75,825 27.12.04 HELLENIC - RC 200,000 EUR 308,600 05.01.05 HELLENIC - PRIVATE DONOR 100 EUR 154 03.01.05 HELLENIC - PRIVATE DONOR 566 12.01.05 HELLENIC - PRIVATE DONOR 15,000 USD 16,980 19.01.05 HUNGARY - PRIVATE DONORS 1,054 24.01.05 ICELAND - GOVT 5,000,000 ISK 88,000 26.12.04 ICELAND - RC 12,000,000 ISK 211,200 26.12.04

Asia - Earthquake and Tsunamis ANNEX 1 APPEAL No. 28/2004 PLEDGES RECEIVED 03/02/2005 IRELAND - GOVT 750,000 EUR 1,155,750 29.12.04 IRELAND - RC 3,000,000 EUR 4,629,000 31.12.04 IRELAND - PRIVATE DONOR 10,000 EUR 15,430 06.01.05 IRELAND - PRIVATE DONORS 455 19.01.05 IRELAND - PRIVATE DONOR 10,000 USD 11,320 21.01.05 ITALY - RC 288,615 EUR 444,756 29.12.04 INDIA (EUR 150'000) ITALIAN - GOVT 103,291 EUR 159,378 20.01.05 SRI LANKA ITALY - PRIVATE DONORS 1,193 10.01.05 ITALY - PRIVATE DONOR 10,000 USD 11,320 18.01.05 ITALY - PRIVATE DONOR 10,000 USD 11,320 19.01.05 ITALY -PRIVATE DONOR 10,000 USD 11,320 20.01.05 AUTON. PROVINCE OF BOZEN 25,000 EUR 38,575 20.01.05 JAPANESE - RC 100,000,000 JPY 1,109,500 28.12.04 JAPANESE - GOVT 15,000,000 USD 16,980,000 17.01.05 SRI LANKA, INDONESIA, MYANMAR, THAILAND, INDIA, SEYCHELLES, MALDIVES, SOMALIA JORDAN - PRIVATE DONOR 16,929 04.01.05 KOREA, REPUBLIC - RC 200,000 USD 226,400 07.01.04 KOREA, REPUBLIC - RC 500,000 USD 566,000 20.01.05 KOREA, REPUBLIC - PRIVATE DONOR 13,000 USD 14,716 20.01.05 KUWAIT - PRIVATE DONOR 1,683 USD 1,905 12.01.05 LATVIA - RC 28,400 EUR 43,821 13.01.05 LATVIA - PRIVATE DONOR 20,000 USD 22,640 03.01.05 LEBANON - PRIVATE DONORS 16,047 13.01.05 LEBANON - PRIVATE DONOR 10,000 USD 11,320 13.01.05 LIBYAN - RC 25,000 06.01.05 LIBYA - PRIVATE DONORS 566 13.01.05 LIECHTENSTEIN - RC 20,000 29.12.04 LITHUANIA - RC 21,460 10.01.05 LUXEMBOURG - GOVT/RC 250,000 EUR 385,750 05.01.05 MALAYSIA - RC 30,000 USD 34,200 30.12.04 BILATERAL FOR INDONESIA, SRI LANKA, INDIA MALAYSIA - PRIVATE DONOR 200,000 MYR 60,500 03.01.05 MALAYSIA - PRIVATE DONOR 2,199 USD 2,490 04.01.05 MALAYSIA - PRIVATE DONORS 1,500 19.01.05 MALTA - PRIVATE DONOR 5,000 EUR 5,660 12.01.05 MAURITIUS - GOVT 50,000 USD 56,600 13.01.05 MAURITIUS - PRIVATE DONOR 15,000 USD 16,980 14.01.05 MEXICO - PRIVATE DONOR 10,000 USD 11,320 14.01.05 MEXICO - PRIVATE DONOR 762 24.01.05 MIRCRONESIA - RC 8,286 FJD 5,717 10.01.05 MONACO - RC 100,000 EUR 151,650 28.12.04 MOROCCO - RC 250,000 MAD 36,330 29.12.04 MOZAMBIQUE - GOVT 100,000 USD 113,200 06.01.05 MYANMAR - PRIVATE DONOR 10,000 USD 11,320 26.01.05 MYANMAR MYANMAR - PRIVATE DONOR 1,553 26.01.05 MYANMAR, INDONESIA, THAILAND, INDIA, SRI LANKA MYANMAR - PRIVATE DONOR 800,850 MMK 143,432 26.01.05 MYANMAR NETHERLANDS - RC 1,000,000 EUR 1,516,500 29.12.04 NETHERLANDS - PRIVATE DONOR 160 EUR 247 05.01.05